The Data Working Group, National Accreditation Program for Breast Centers, American College of Surgeons, Chicago, IL, USA.
Department of Surgery, Case Western Reserve University, University Hospitals, Cleveland, OH, USA.
Ann Surg Oncol. 2019 May;26(5):1202-1211. doi: 10.1245/s10434-018-07108-7. Epub 2019 Jan 25.
This study was designed to determine whether accreditation by the National Accreditation Program for Breast Centers (NAPBC) is associated with improved performance on six breast quality measures pertaining to adjuvant treatment, needle/core biopsy, and breast conservation therapy rates at Commission on Cancer (CoC) centers.
National Cancer Database 2015 data were retrospectively reviewed to compare patients treated at CoC centers with and without NAPBC accreditation for compliance on six breast cancer quality measures. Mixed effects modeling determined performance on the quality measures adjusting for patient, tumor, and facility factors.
Of 1308 CoC facilities, 484 (37%) were NAPBC-accredited and 111,547 patients (48%) were treated at NAPBC centers. More than 80% of patients treated at both NAPBC and non-NAPBC centers received care in compliance with breast quality measures. NAPBC centers achieved significantly higher performance on four of the five quality measures than non-NAPBC centers at the patient level and on five of six measures at the facility level. For two measures, needle/core biopsy before surgical treatment of breast cancer and breast conservation therapy rate of 50%, NAPBC centers were twice as likely as non-NAPBC centers to perform at the level expected by the CoC (respectively odds ratio [OR] 1.96, 95% confidence interval [CI] 1.85-2.08, p < 0.0001; and OR 2.05, 95% CI 1.94-2.15, p < 0.0001).
While NAPBC accreditation at CoC centers is associated with higher performance on breast quality measures, the majority of patients at all centers receive guideline-concordant care. Future studies will determine whether higher performance translates into improved oncologic and patient-reported outcomes.
本研究旨在确定国家乳腺中心认证计划（NAPBC）的认证是否与癌症委员会（CoC）中心在辅助治疗、针芯活检和保乳治疗率方面的六项乳腺质量指标的改善表现相关。
回顾性分析 2015 年国家癌症数据库的数据，比较 CoC 中心有无 NAPBC 认证的患者在遵守六项乳腺癌质量指标方面的表现。混合效应模型调整患者、肿瘤和医疗机构因素后，确定质量指标的表现。
在 1308 个 CoC 机构中，484 个（37%）是 NAPBC 认证机构，111547 名（48%）患者在 NAPBC 中心接受治疗。在 NAPBC 和非 NAPBC 中心接受治疗的患者中，超过 80%的患者接受了符合乳腺质量指标的治疗。在患者层面，NAPBC 中心在五项质量指标中的四项指标上的表现明显优于非 NAPBC 中心，在机构层面的六项指标中的五项指标上的表现也优于非 NAPBC 中心。在两项指标中，乳腺癌手术治疗前的针芯活检和保乳治疗率为 50%，NAPBC 中心比非 NAPBC 中心更有可能达到 CoC 预期的水平（分别为比值比 [OR] 1.96，95%置信区间 [CI] 1.85-2.08，p<0.0001；和 OR 2.05，95% CI 1.94-2.15，p<0.0001）。
尽管 CoC 中心的 NAPBC 认证与乳腺质量指标的更高表现相关，但大多数中心的患者都接受了符合指南的治疗。未来的研究将确定更高的表现是否转化为改善的肿瘤学和患者报告的结果。
